POS0486 CHARACTERISTICS OF RHEUMATOID ARTHRITIS PATIENTS WHO ACHIEVE REMISSION AFTER 2022 AMERICAN COLLEGE OF RHEUMATOLOGY/EUROPEAN ALLIANCE OF ASSOCIATION FOR RHEUMATOLOGY REVISED REMISSION CRITERIA APPLICATION
Authors: Y. Hirano, Y. Saito
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> In 2011, the American College of Rheumatology (ACR) and European League Against Rheumatism (formerly European Alliance of Association for Rheumatology [EULAR]) developed two new definitions for remission for rheumatoid arthritis (RA) clinical trials and in clinical practice [1]: Boolean-based definition and index-based definition (simplified disease activity index: SDAI). The 2011 Boolean based definition (Boolean 1.0 [B1R]) required each of the four core set variables (tender joint count, swollen joint count, patient assessment of global disease activity [PtGA, cm], and C-reactive protein [CRP, mg/dl]) to have a value of ≤1. B1R is the most stringent remission criteria and discrepancies between B1R and SDAI were highlighted. In 2022, the ACR and EULAR validated and approved a Boolean remission (Boolean 2.0 [B2R]) revision in which the PtGA threshold was set at ≤2 [2]. Although the RA patient number who achieved remission by B2R definition increased due to the PtGA threshold change, the characteristics of those who were newly included in the remission criteria are unknown. <h3>Objectives</h3> This cross-sectional retrospective study investigated the characteristics of RA patients who were newly included in the remission criteria after B2R application in daily clinical practice. <h3>Methods</h3> Toyohashi RA Database (TRAD) data from 2021 was used, which is a single-center retrospective data collection. Once a year cross-sectional data was included in TRAD such as basic patients' characteristics, RA disease activity, laboratory data, and medication data. A total of 469 RA patients and 611 RA patients were categorized in B1R and in B2R, respectively, among the 1020 RA patients registered in the TRAD 2021 data. New remission criteria entries after B2R application were 142. Cross-sectional data described below were compared between B1R and B2 1R: age, gender, RA disease duration, rheumatoid factor (RF) positivity and anti-cyclic citrullinate protein antibody (ACPA), Steinbrocker stage and class, medication information at the time of survey, CRP value and erythrocyte sedimentation rate, modified health assessment questionnaire (mHAQ), and concomitant osteoporosis (OP). Univariate analysis by Mann Whitney U-test or Chi square test was initially performed between B1R and B2-1R. Subsequently, multivariate analysis was performed using selected variables, which were statistically significant between the two groups by logistic regression analysis. P &lt; 0.05 was considered as statistically significant. <h3>Results</h3> The number of RA patients in remission state increased by 30.3% by B2R application. Statistically significant differences by univariate analysis were found in the following variables (mean values or percentage in B1R/B2-1R): RA disease duration (11.3/15.5 years), RF positive ratio (70.2/79.9%), RF titer (94.4/132.8 IU/ml), ACPA positive rate (71.5/80.9%), ACPA titer (226.9/322.3 U/ml), %stage III+IV (45.6/63.4%), %btDMARDs (40.1/51.4%), mHAQ (0.11/0.28), and %OP concomitant (32.0/46.5%). Multivariate analysis results were shown in the Table 1. mHAQ in B2-1R was significantly worse compared with that in B1R. <h3>Conclusion</h3> New B2R application increased the RA patient number in remission state. RA patient characteristics in B2-1R were with: longer disease duration, more seropositivity, more joint damage, treated with more intensive medications, especially worse physical function, and increased concomitant OP. <h3>References</h3> [1]Felson DT et al. Ann Rheum Dis 2011. [2]Studenic P et al. Ann Rheum Dis 2022. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.